Provider Demographics
NPI:1215273982
Name:NAM, ANTHONY (LMT, LAC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BUSINESS PARK DR STE 308
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1751
Mailing Address - Country:US
Mailing Address - Phone:347-781-5067
Mailing Address - Fax:
Practice Address - Street 1:200 BUSINESS PARK DR STE 308
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1751
Practice Address - Country:US
Practice Address - Phone:347-781-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27025419225700000X
NY25005130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist